THE FOLLOW UP
Feb 02, 2026 · news.va.gov
Niche News

VA raises expenditure cap to cover full cost of in-home and community care for veterans with complex conditions

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Key takeaways

  • VA increased the expenditure cap for in-home and community-based services from 65% to 100% of the cost of comparable care in a VA Community Living Center.
  • The change applies to Veterans with spinal cord injuries, Amyotrophic Lateral Sclerosis, and other complex medical conditions under the skilled home health care program.
  • Covered services include home health aide, home respite, community adult day health care, Veteran Directed Care, and skilled home health.
  • VA expects about 200 Veterans to take advantage of the higher cap in fiscal year 2026; the skilled home health program has enrolled approximately 1,800 Veterans since 2019.
  • The rate increase implements Section 120 of the Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act of 2025.
  • VA advises Veterans and their families to speak with their VA social worker to learn more; media inquiries go to vapublicaffairs@va.gov.

Follow Up Questions

Which Veterans exactly qualify for the 100% expenditure cap — how is eligibility determined?Expand

Short answer: The 100% cap applies to Veterans who are enrolled in VA, eligible for VA community care and meet the clinical criteria for VA’s home‑and‑community skilled care; Congress and VA specifically name Veterans with amyotrophic lateral sclerosis (ALS) and spinal‑cord injuries and permit VA to treat “similar” conditions as eligible. VA bases eligibility on clinical need and program criteria (social‑worker/case‑manager assessment).

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How does VA calculate the "cost of similar care in a VA Community Living Center" when setting the cap amount?Expand

Short answer: VA calculates the comparator as the nursing‑home rate for that fiscal year (the per‑patient cost in a VA Community Living Center) for the veteran’s VISN/region; the expenditure cap is expressed as a percentage of that published nursing‑home (CLC) rate.

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What steps must a Veteran or family take to have in-home or community-based services covered at the new cap?Expand

Short answer: Contact your VA social worker/case manager, request an evaluation, and complete the Application for Extended Care Benefits (VA Form 10‑10EC) so VA can determine clinical eligibility and enroll the veteran in the Skilled Home Health Care / other HCB programs; VA then authorizes services and applies the new cap when it purchases care from VA‑contracted community providers.

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Are there annual or per-Veteran dollar limits on the expenditures VA will cover under the new 100% rate?Expand

Short answer: There is not a fixed dollar number; the cap is fiscal‑year limited and set as a percentage (now 100%) of the annual nursing‑home (VA CLC) rate for the veteran’s region. VA may approve costs above that amount on a case‑by‑case basis for high‑need veterans (e.g., ALS or spinal‑cord injury) after clinical review.

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Will this change apply when Veterans receive care from non-VA community providers, and how are payments handled to those providers?Expand

Short answer: Yes. The change applies to VA‑purchased care from community providers (the Skilled Home Health program is delivered by VA‑contracted community home‑health agencies). VA pays those providers under its purchased‑care/contracting authorities and will apply the 100% CLC‑rate cap to VA’s purchased payments; veterans/families should coordinate with their VA social worker to arrange VA‑purchased services.

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When does the new 100% cap take effect for eligible Veterans and is there a retroactive application for recent claims?Expand

Short answer: The Federal Register notice says VA’s implementation was effective September 11, 2025. The Federal Register notice and VA release do not state a general retroactive reimbursement policy; VA will apply the higher cap going forward and will consider exceptions (costs >100%) case‑by‑case per the statute.

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